MDCT Versus MRI Assessment of Tumor Response After Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma

Journal Article · Tue Jun 15 00:00:00 EDT 2010 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-009-9728-Y· OSTI ID:21428992

Kloeckner, Roman ^[1]; Otto, Gerd ^[2]; Biesterfeld, Stefan ^[3]; Oberholzer, Katja; Dueber, Christoph; Pitton, Michael B ^[1]

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1. Johannes Gutenberg-University of Mainz, Department of Diagnostic and Interventional Radiology (Germany)
2. Johannes Gutenberg-University of Mainz, Department of Transplantation and Hepatobiliary Pancreatic Surgery (Germany)
3. Johannes Gutenberg-University of Mainz, Department of Pathology (Germany)

The purpose of this study was to compare the ability of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) to evaluate treatment results after transarterial chemoembolization (TACE), with a special focus on the influence of Lipiodol on calculation of tumor necrosis according to EASL criteria. A total of 115 nodules in 20 patients (17 males, 3 females; 69.5 {+-} 9.35 years) with biopsy-proven hepatocellular carcinoma were treated with TACE. Embolization was performed using a doxorubicin-Lipiodol emulsion (group I) or DC Beads loaded with doxorubicin (group II). Follow-up included triphasic contrast-enhanced 64-row MDCT (collimation, 0.625 mm; slice, 3 mm; contrast bolus, 120 ml iomeprol; delay by bolus trigger) and contrast-enhanced MRI (T1 native, T2 native; five dynamic contrast-enhanced phases; 0.1 mmol/kg body weight gadolinium-DTPA; slice thickness, 4 mm). Residual tumor and the extent of tumor necrosis were evaluated according to EASL. Contrast enhancement within tumor lesions was suspected to represent vital tumor. In the Lipiodol-based TACE protocol, MDCT underestimated residual viable tumor compared to MRI, due to Lipiodol artifacts (23.2% vs 47.7% after first, 11.9% vs 31.2% after second, and 11.4% vs 23.7% after third TACE; p = 0.0014, p < 0.001, and p < 0.001, respectively). In contrast to MDCT, MRI was completely free of any artifacts caused by Lipiodol. In the DC Bead-based Lipiodol-free TACE protocol, MRI and CT showed similar residual tumor and rating of treatment results (46.4% vs 41.2%, 31.9 vs 26.8%, and 26.0% vs 25.6%; n.s.). In conclusion, MRI is superior to MDCT for detection of viable tumor residuals after Lipiodol-based TACE. Since viable tumor tissue is superimposed by Lipiodol artifacts in MDCT, MRI is mandatory for reliable decision-making during follow-up after Lipiodol-based TACE protocols.

• OSTI ID: 21428992
• Journal Information: Cardiovascular and Interventional Radiology, Vol. 33, Issue 3; Other Information: DOI: 10.1007/s00270-009-9728-y; Copyright (c) 2010 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); ISSN 0174-1551
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
COMPUTERIZED TOMOGRAPHY
DOXORUBICIN
HEPATOMAS
LIPIODOL
NECROSIS
NMR IMAGING
ANTIBIOTICS
ANTI-INFECTIVE AGENTS
ANTINEOPLASTIC DRUGS
CARCINOMAS
CONTRAST MEDIA
DIAGNOSTIC TECHNIQUES
DISEASES
DRUGS
NEOPLASMS
OILS
ORGANIC COMPOUNDS
ORGANIC HALOGEN COMPOUNDS
ORGANIC IODINE COMPOUNDS
OTHER ORGANIC COMPOUNDS
PATHOLOGICAL CHANGES
TOMOGRAPHY